Relationship between serum cystatin C and hypertension among US adults without clinically recognized chronic kidney disease

Abstract

Background Previous animal studies have suggested that mild reductions in renal function, even before the development of clinically recognized chronic kidney disease (CKD), are associated with hypertension. However, few studies have examined this hypothesis in humans. We therefore examined the association between serum cystatin C levels and hypertension among subjects without clinically recognized CKD in a large multiethnic sample of US adults. Methods We examined the National Health and Nutrition Examination Survey 1999–2002 participants >20 years of age (n=2583, 54.5% women) without clinically recognized CKD (defined as an estimated glomerular filtration rate<60 mL/min/1.73 m2 or microalbuminuria). Serum cystatin C levels were categorized into quartiles (<0.76 mg/L, 0.76–0.86 mg/L, 0.87–0.97 mg/L, >0.97 mg/L). Hypertension was defined as blood pressure (BP)-reducing medication use or having systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. Results Higher serum cystatin C levels were found to be associated with hypertension in women, but not men. After adjusting for age, race-ethnicity, education, smoking, alcohol intake, body mass index, diabetes, total cholesterol and C-reactive protein, the odds ratio (95% confidence interval) of hypertension comparing quartile 4 of cystatin C to quartile 1 (referent) was 2.04 (1.13–3.69); p-trend=0.02 in women and 0.86 (0.53–1.41); p-trend=0.51 in men. Conclusion In a representative sample of US adults, mild reductions in kidney function as measured by higher serum cystatin C levels among subjects without clinically recognized CKD are associated with hypertension in women, but not men.

Reference Intervals for Serum Cystatin C and Factors Influencing Cystatin C Levels Other than Renal Function in the Elderly

“…Some studies have reported that the prevalence of an elevated Scys-C in the general population was found to be high and was associated with the presence of classical cardiovascular risk factors such as DM, hypertension [12], [16], [17]. But, DM was not an influencing factor in our study.…”

Biomarker response to contrast administration in diabetic and nondiabetic patients following coronary angiography

“…[4] Nephrotoxicity of contrast media is dependent on the type of contrast medium, with low-osmolal, nonionic contrast media being more nephrotoxic compared to iso-osmolal contrast medium. [8] This was further confirmed in the study by Malyszko et al .,[14] with the diabetic patients who received low-osmolal contrast medium having significantly higher u-NGAL levels 4 h after percutaneous coronary intervention compared to diabetic patients who received iso-osmolal contrast agent. Thus, the biomarker response in the two groups receiving different contrast medium cannot be generalized and hence points to the need of studying the markers in a homogenous group receiving the same type of contrast medium.…”

“…Low-osmolal, nonionic contrast media have been shown to be more nephrotoxic compared to iso-osmolal contrast medium. [8] The incidence using high-osmolal contrast agents in a recent study was found to be 51.4%. [24] Incidence is lower among those who receive prophylactic measures (saline hydration, N-acetylcysteine, theophylline) compared to those who do not.…”

“…Patient-related risk factors such as advanced age, presence of diabetes mellitus (DM),[7] hypertension[8] baseline renal insufficiency,[9] arterial hypotension, hypovolemia, hypercholesterolemia, hyperuricemia, and female gender along with procedure-related risk factors such as osmolality of contrast media,[10] volume,[3] and route of administration can influence the development of CIN as well as biomarker concentration. Diabetic patients are at increased risk of developing CIN.…”

Cystatin C in healthy middle-aged adults: A relationship with anthropometric and cardiometabolic parameters

“…Namely, Salgado et al (22) reported the association of SBP, but not DBP, with serum cystatin C levels. On the other hand, Mena et al (23) found that DBP negatively correlated with cystatin C, while Shankar et al (24) confirmed that mild reductions in kidney function as measured by serum cystatin C levels among subjects without clinically recognized chronic kidney disease were associated with hypertension in women, but not in men.…”